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General NPI Number Information
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NPI Number | 1174649818
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Entity Type | Individual
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Provider Name | PEGGY DAGLIAN M.A.
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 12/23/2010
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Provider Practice Location Address
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Address Line | 66 HURLBUT ST
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City | PASADENA
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State | CA
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Zip | 91105-4025
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Country | US
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Telephone | 626-447-4221
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E PROVIDENCIA AVE # 109
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City | BURBANK
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State | CA
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Zip | 91502-2791
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Country | US
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Telephone | 818-468-3798
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 49216
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License Number State | CA
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